Provider Demographics
NPI:1497730915
Name:HOPKE, GRETA ANN GOODPASTURE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:ANN GOODPASTURE
Last Name:HOPKE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44871 HIGHWAY WW
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:63382-4501
Mailing Address - Country:US
Mailing Address - Phone:573-594-2826
Mailing Address - Fax:
Practice Address - Street 1:19 N MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-1643
Practice Address - Country:US
Practice Address - Phone:573-324-2111
Practice Address - Fax:573-324-3057
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005015547133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005015547OtherSTATE OF MISSOURI LICENSE
MO2005015547OtherSTATE OF MISSOURI LICENSE